Prediction of disturbed eating attitudes in adolescent girls: a 3-year longitudinal study of eating patterns, self-esteem and coping.

OBJECTIVE: The purpose was to examine the extent to which yearly assessments of eating patterns and attitudes, self-esteem and coping strategies over a 3-year period among adolescent girls predicted the degree of disturbed eating attitudes at the year 3-assessment. Our main hypothesis was that such attitudes year 3 would be predicted by eating attitudes, restrained, emotional, and external eating behaviour, as well as by low self-esteem and coping by acting out or avoidance. METHOD: Three-hundred and seventy- eight Swedish adolescent girls were assessed once a year for three years. RESULTS: The results suggest that eating patterns and attitudes were the strongest predictors of disturbed eating attitudes year 3. Self-esteem and coping had a limited predictive value for eating attitudes year 3, and the effect of self-esteem appeared to be mediated by coping. DISCUSSION: The results suggest that early eating patterns (e.g., more disturbed eating attitudes and restrained eating behaviors) and attitudes are potentially important predictors for the development of more serious eating disturbances among adolescent girls.

Psychosocial adjustment among women with breast cancer stages I and II: six-year follow-up of consecutive patients.

PURPOSE: To evaluate, in a long-term follow-up study of consecutive patients (N = 99), the impact of surgery--breast-conserving treatment (BCT) versus mastectomy (MT)--on psychosocial adjustment among women with breast cancer, pTNM stage I/II. PATIENTS AND METHODS: Semistructured interviews were conducted at a median of 6 years (range, 5.8 to 8.1) after primary surgery. Sixty-six women were available for the long-term follow-up study. Twenty-six women had been treated with BCT and 40 with MT. RESULTS: No statistically significant differences were found between the two groups concerning psychosocial adjustment, as measured by the Social adjustment Scale (SAS). In general, the levels of maladjustment were lower than at 13 months postoperatively, but 10% still showed maladjustment. Sixty percent of the women were unwilling to show themselves naked, and 22% felt that they had become less attractive because of the surgical treatment. In an explorative part of the interview, 68% of the women complained about how they had been informed of the diagnosis. A tendency toward a significant difference was found in the relation between previous maladjustment and a negative experience at the time of diagnosis (P = .07). CONCLUSION: Few data are available on long-term follow-up results with regard to psychosocial adjustment among women after breast cancer surgery. This study provides the important information that there are no differences in patient psychosocial adjustment that can be ascribed to the type of surgery at 6-year follow-up evaluation.

Effect of endocrine treatment on sexuality in premenopausal breast cancer patients: a prospective randomized study.

PURPOSE: To study the sexual effects of the 2-year adjuvant goserelin (Zoladex [Zeneca AB, Södertälje, Sweden]) alone, tamoxifen alone, and Zoladex and tamoxifen in combination (ZT) versus no adjuvant endocrine therapy among premenopausal breast cancer patients with or without chemotherapy in a controlled clinical trial (a European multicenter trial: Zoladex in Premenopausal Breast Cancer Patients). PATIENTS AND METHODS: This prospective study examined several aspects of sexuality through the use of self-administered questionnaires, which were completed by patients at seven points of assessment for 3 years after randomization. RESULTS: Patients treated with chemotherapy had a higher level of sexual dysfunction than did patients who received no systemic treatment. The addition of endocrine treatment did not alter this result. In contrast, among patients who did not receive chemotherapy, Zoladex and ZT produced a significantly higher level of dysfunction from 1 to 2 years after inclusion, as compared with those who received no endocrine treatment. Tamoxifen alone did not produce side effects. After termination of endocrine treatment, sexual dysfunction began to diminish. Those with chemotherapy had high and frequently increasing levels of dysfunction even after 2 to 3 years of independent of endocrine treatment. Zoladex had a negative effect on sexual fear, which was reduced by the addition of tamoxifen. CONCLUSION: Zoladex increased sexual dysfunction during treatment among patients without chemotherapy, but the disturbances of sexual functioning were reversible. The use of adjuvant chemotherapy was associated with continued sexual problems, even at 3 years after randomization.

Consumer choice and suggested price for pork as influenced by its appearance, taste and information concerning country of origin and organic pig production.

Reactions of consumers to the appearance and taste of pork with and without information concerning outdoor production of pigs were tested in France, Denmark, Sweden and UK. Consumers in all four countries focussed on colour and fatness rather than marbling and drip to make their choice. Almost half of the British and Danish preferred the paler and the French the darker pork. Most people preferred the leaner pork. When information was provided in the form of labels, the vast majority of consumers preferred the pork labelled as originating from their own country as opposed to 'imported' and that labelled as pork from pigs 'raised outside' as opposed to 'inside'. There was no difference in the taste of grilled pork from indoor and outdoor production systems but pork labelled 'home produced' or 'outdoor' were more appreciated. Consumers' willingness to pay varied widely and was higher for those consumers who found more of the characteristics they sought. Consumers offered about 5% more for 'home country' and 'raised outside' labels.

The influence of a false-positive mammogram on a woman's subsequent behaviour for detecting breast cancer.

The aim was to investigate the influence of undergoing further examinations due to a false-positive mammogram on women's re-attendance at the next scheduled screening and their frequency of breast self-examination (BSE). Study participants included 517 women (62% response) recalled due to findings on screening mammograms indicating possible malignancies, and a matched control group of 285 women (68% response) with normal mammograms. Participants completed five and three questionnaires, respectively, during the 2 years following screening participation. While the groups did not differ significantly in screening re-attendance, women recalled due to false-positive mammograms reported significantly higher levels of anxiety related to the next screening than did women with normal mammograms. At the 1-year assessment, women with false-positive mammograms reported a significantly higher frequency of BSE than did women with normal mammograms. The present results indicate that being recalled due to a false-positive mammogram does not seem to negatively affect screening re-attendance, and may have a positive impact on BSE.

Psychological reactions in patients with malignant melanoma.

Psychological and psychosomatic reactions to malignant melanoma were studied, comparing patients with tumour thickness < or = 0.8 mm versus > 0.8 mm and recurrent versus non-recurrent patients. Gender differences were also studied. Consecutive melanoma patients, Stage I (n = 144), were interviewed at their first postsurgery follow-up visit to an oncology clinic and completed questionnaires 7 and 13 months later. The questionnaire contained items regarding interest in nevi, sleeping problems, psychosomatic complaints, and the Hospital Anxiety and Depression Scale. Patients with a more unfavourable prognosis (tumour thickness > 0.8 mm), subjected to regular medical procedures, did not differ from those with a more favourable prognosis (< or = 0.8 mm), except reporting more sleeping problems. Women had considerably higher levels of problems than men. Amongst patients with an unfavourable prognosis, those with recurrence within 2 years showed lower levels of anxiety at the first visit compared with those free from recurrence after 2 years.

One-year follow-up of the 'Starting Again' group rehabilitation programme for cancer patients.

In a randomised prospective study, a brief structured rehabilitation programme, 'Starting Again', was evaluated over a follow-up year. 98 patients were assigned to the programme, and 101 to the control condition. The 11, 2-h sessions emphasised physical training, information and coping skills. Patients in the programme improved significantly more than the controls with respect to appraisal of having received sufficient information, physical training, physical strength and fighting spirit. Results indicate improvement with respect to the three areas focused on in the 'Starting Again' programme: physical training, information and coping skills training.

Short- and long-term anxiety and depression in women recalled after breast cancer screening.

The aim was to investigate the psychological consequences of further investigation after breast cancer screening. Study participants include 509 women (61%) recalled due to suspicious findings on screening mammograms, and a matched control group of 285 women (68%) with normal mammograms. Psychological distress was prospectively assessed with the Hospital Anxiety and Depression Scale (HADS). 46% of the women reported borderline or clinically significant anxiety prior to the recall visit. A few days after the visit, anxiety and depression had decreased significantly (P<0.01) in women informed about normal or benign results at the recall clinic, while reported distress remained at relatively high levels in women referred to surgical biopsy. The results demonstrate the adverse short-term effect of a delay in receiving false-positive results, but do not indicate that the recall experience results in long-term anxiety or depression for a majority of women.

Predicting anxiety and depression among cancer patients: a clinical model.

The aim of this study was to investigate the possibility of predicting anxiety and depression 6 months after the cancer diagnosis on the basis of measures of anxiety, depression (Hospital Anxiety and Depression, HAD scale), subjective distress (Impact of Event, IES scale) and some aspects of social support in connection with the diagnosis. A further purpose was to attempt identification of individual patients at risk of prolonged psychological distress, and to develop an easily applicable clinical tool for such detection. A consecutive population-based series of 522 newly diagnosed patients with breast, colorectal, gastric and prostate cancer were interviewed in connection with the diagnosis and 6 months later. Anxiety and depression close to the diagnosis explained 39% of the variance in anxiety and depression 6 months later. Patients scoring as doubtful cases/cases for HAD anxiety and/or depression were more than 11 times more likely than non-cases to score as doubtful cases/cases at 6 months. Additional risk factors were having an advanced disease and nobody in addition to the family to rely on in case of difficulties. Levels of anxiety and depression at diagnosis predict a similar status 6 months later. The results also indicate that the HAD scale in combination with a single question about social support may be a suitable screening tool for clinical use.

Psychosocial adjustment among husbands of women treated for breast cancer; mastectomy vs. breast-conserving surgery.

Psychosocial adjustment was measured among 56 spouses of women operated for breast cancer. Of 69 eligible husbands, 56 participated. Twenty women underwent breast-conserving surgery (BCT) and 36 had a mastectomy (MT). An interview was conducted with each woman and her husband separately, 4 and 13 months after surgery. Two instruments were used; SBAS (Social Behaviour Assessment Schedule) and a scale (TB) constructed specifically for the study. The husbands of the women in the MT group were significantly more depressed after 4 months and reported complaints related to their wive's disease more often than did those in the BCT group. After 4 months, the marital relation was assessed as more positive in the MT group. A total of 48% of the husbands in the sample expressed some emotional distress during the investigation period, which is similar to levels seen among breast cancer-operated women themselves. Overall, only marginally better scores were seen for husbands married to women who had undergone breast-conserving surgery. Few researchers have studied psychosocial reactions in the breast cancer patient's family. Since patterns of social support empirically influence the rehabilitation of the cancer patient, this field of investigation is important.

Psychological effects of participation in a prevention programme for individuals with increased risk for malignant melanoma.

The Swedish Melanoma Study Group runs a programme aimed at prevention and early detection of premalignant and malignant melanoma in families with two or more members having malignant melanoma. Psychological consequences of participation in this programme were studied. A questionnaire containing items concerning cognitive and emotional responses to the programme was completed by 115 consecutive individuals at their first visit to the clinic. The same questionnaire was administered by mail 7 months later. The levels of psychological and psychosomatic problems were relatively low at both points of assessment. No negative psychological effects were found, neither in the group with dysplastic naevus syndrome (DNS) with increased risk for malignant melanoma, nor in the group without dysplastic naevi. Only one variable, "emotional responses to the visit" differentiated between the groups, with higher scores in the group without DNS. A majority of the individuals expressed positive attitudes to the clinic.

Psychological reactions in public melanoma screening.

Participants in public screening for malignant melanoma (n = 190) completed a questionnaire containing items regarding cognitive and emotional responses to skin examination on two occasions, before screening and 7 months later. The results suggest subjective susceptibility to melanoma in participants in public screening, especially in women. No increase in psychosomatic problems, anxiety or depressive symptoms or signs of "false security" were seen as an effect of the screening, neither in the total sample nor in those who at the screening were recommended further medical procedures.

Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients.

Late effects of adjuvant treatment on perceived health and quality of life were assessed through a questionnaire mailed to 448 premenopausal and postmenopausal breast cancer patients, free from recurrence 2-10 years after primary therapy. The patients had been randomised to postoperative radiotherapy or adjuvant chemotherapy as adjuncts to primary surgery. The differences between the two treatments were generally small. However, the radiotherapy patients had significantly greater problems with decreased stamina, symptoms related to the operation scar and anxiety. The chemotherapy patients had significantly more problems with smell aversion. Activity level inside and outside the home, anxiousness and depressive symptoms were similar in both groups. The chemotherapy patients scored their overall quality of life higher than the radiotherapy patients.

Reduced utilisation of specialist care among elderly cancer patients: a randomised study of a primary healthcare intervention.

The aim of this study was to evaluate the effect of an individual support (IS) intervention including intensified primary healthcare on the utilisation of specialist care among cancer patients, and to investigate if such an effect was modified by the patient's age (less than 70 years or 70 years and more). Newly diagnosed cancer patients (n=416) were randomised between the intervention and a control condition, and data were collected on the utilisation of specialist care within 3 months from inclusion. Intensified primary healthcare comprised extended information from the specialist clinics, and education and supervision in cancer care for general practitioners (GPs) and home-care nurses. The support given also included interventions designed to diminish problems of weight loss and psychological distress. The intervention reduced the number of admissions (NoA) and the days of hospitalisation (DoH) after adjustment for weight loss and psychological distress, but only for older patients. Older patients randomised to the intervention (n=82) experienced 393 fewer DoH than the older control patients (n=79). In addition, the proportion of older patients in the IS group who utilised acute specialist care was smaller compared with older control patients group. The conclusion is that older cancer patients' utilisation of specialist care may be reduced by intensified primary healthcare services.

Quality of life in patients with multiple endocrine neoplasia type 1 (MEN 1).

To study quality of life among patients living with a hereditary tumor syndrome, the small group with multiple endocrine neoplasia type 1 (MEN1) was selected. It is characterized by multifocal adenomas of the pancreas, parathyroid, anterior pituitary and other endocrine glands. Patients were assessed at an in-hospital stay and six months later at home. Patients at a specialist ward for MEN1 were recruited consecutively (n = 36) during one year. Eighty-one percent participated (n = 29). Four questionnaires were used: the Hospital Anxiety and Depression Scale (HADS), the Impact of Event Scale (IES), the Life Orientation Test (LOT) and the Short Form-36 (SF-36). Psychosocial outcome measures (anxiety, depression, intrusion, avoidance) changed only marginally between the in hospital stay and six months later at home. However, depression increased for patients categorized as having a high burden of disease and treatment. Compared to population-based norm values, the SF-36 scores of the patient group MEN1were lower for General Health and Social Functioning. Optimism assessed at the hospital was a predictor of Mental Health six months later. Most MEN 1 patients (70%) were pessimists. Patients having a higher burden of disease and treatment are in need of support after discharge. Patients could easily be monitored with questionnaires and, when indicated, offered help for their psychosocial distress.

Respiratory function, electrocardiography and quality of life in individuals with muscular dystrophy.

All individuals in a Swedish county afflicted with any type of hereditary muscular dystrophy (MD) were identified and 57 (85 percent) of eligible individuals in the age range 16 to 64 were included in the study. Respiratory disturbances were estimated by means of spirometry and analysis of arterial blood gases, and 58 percent yielded abnormal results on at least one of these examinations. Elevated PCO2 was found more commonly than reduced forced vital capacity (FVC) and there was a moderate association between these parameters. Respiratory symptoms, most commonly breathlessness, were encountered in 79 percent. Pathologic ECG recordings were found in 21 individuals (37 percent). Conduction disturbances and affection of the myocard were most frequent in myotonic dystrophy. Quality of life was assessed by means of the Sickness Impact Profile instrument and the Kaasa test. The results showed that quality of life was significantly related to FVC and to the symptom of abnormal fatigue. Respiratory and cardiac parameters showed a greater number of significant correlations with measures of functional ability than with subjective well-being.

Assessment of sun-related behaviour in individuals with dysplastic naevus syndrome: a comparison between diary recordings and questionnaire responses.

In Sweden, individuals with dysplastic naevus syndrome (DNS-D2), a high risk group for malignant melanoma, are regularly screened and informed about self-examination and sun protection. During the summer of 1994, 54 out of 65 consecutive patients completed 1 month of daily self-recordings of sun-related behaviour. The diary report was compared with questionnaire responses obtained 6 months later concerning sun-related behaviour, both habitual and during the month of self-recording. The correspondence between the sun-related behaviour recorded in the diary and given in response to the questionnaire was fairly high, but 48% underestimated and 29% overestimated their actual number of sunbathing occasions in the questionnaire. Few patients indicated habitual high frequencies of sunbathing, although some of them recorded six or more occasions during 1 month in the diary. Those who recorded multiple sunburns reported the highest number of sunburns in the questionnaire. Patients who scored high on sunbed use also recorded high numbers of sunbathing occasions. Diaries should be used when detailed information about the magnitude of sun-related behaviour is essential, whereas questionnaires should be sufficient in studies aiming to differentiate between high and low frequencies of such behaviour.

The Swedish version of the patient-generated subjective global assessment of nutritional status: gastrointestinal vs urological cancers.

PURPOSE: To translate and evaluate the Patient-Generated Subjective Global Assessment (PG-SGA) a method for the assessment of nutritional status. METHOD: Eighty-seven patients with gastrointestinal and urological tumours completed four sections and the remaining sections were independently completed by a doctor and a dietician. Patients were classified as SGA A (well nourished), SGA B (moderately/suspected of being malnourished) or SGA C (severely malnourished). RESULTS: Interobserver agreement was complete in 90% of the cases. More patients with gastrointestinal cancers than with urological cancers were classified as SGA B and C. Mean levels of S-albumin and P-prealbumin differed between the SGA-classes. Multivariate logistic regression analyses showed independent contributions to the overall classification by weight loss in the last 6 months, level of food intake, problems with eating, physical activity and muscle wastage. Survival was significantly higher in SGA A than in SGA B+C, P < 0.001. CONCLUSION: The PG-SGA is useful for the assessment of nutritional status. Patients had no problems in answering the questions. The PG-SGA also carried prognostic information.

Conditioned taste aversion to saccharin induced by 2, 4, 5-trichlorophenoxyacetic acid in albino rats.

Four groups of Wistar rats were exposed either to saccharin + 2,4,5-T (taste-aversion group, T-A), saccharin + oil vehicle (taste-aversion control, T-A C), water + 2,4,5-T (enhanced neophobia, E-N), or water + oil (neophobia, N). Rats in the T-A group evidenced a marked aversion to saccharin in 3 consecutive preference tests, performed every third day, starting 3 days after exposure. The aversion was less pronounced, although statistically significant in 2 additional preference tests, performed respectively after a 9-day rest period of ad lib water drinking, and a 24 hr period of forced exposure to saccharin. An enhanced neophobia effect was found in the E-N group in the first preference test. Suggestions are made concerning the possible long-term effects on food preferences among wild-living animals as a result of large-scale application of 2,4,5-T-containing herbicides.

Inhibition of anticipatory salivation and craving in response to food stimuli.

Two experiments were done to study inhibition of cue-dependent salivation and craving responses. Experiment 1 suggests that total prevention of tasting during cue exposure inhibits salivation responses to chocolate cues. On the other hand, salivation was triggered by chocolate cues after tasting a very small amount of chocolate, indicating a very robust and rapid learning of conditioned salivation responses. However, prevention of tasting during cue exposure did not affect craving, suggesting that this method cannot decrease craving or that craving is affected at different rate than salivation. Experiment 2 tested the hypothesis that tasting irrelevant food during repeated exposure to chocolate cues would inhibit anticipatory salivation and craving responses to these cues. No support for this hypothesis was observed.